Provider Demographics
NPI:1982201794
Name:GARRISON, ELISE
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:GARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 E WALKER ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-2203
Mailing Address - Country:US
Mailing Address - Phone:530-865-1165
Mailing Address - Fax:
Practice Address - Street 1:604 E WALKER ST
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-2203
Practice Address - Country:US
Practice Address - Phone:530-865-1165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator